[Settlement of the surgical treatment of lipoedema]. / Abrechnung der chirurgischen Therapie des Lipödems.

The billing of lipoedema treatment in Germany has come to be heterogeneous. This is due to the decision of the Federal Joint Committee ("Gemeinsamer Bundesausschuss", G-BA) to acknowledge lipoedema stage III as a treatment to be paid by the statutory health insurance funds ("Gesetzliche Krankenversicherung", GKV) until the completion of the trial study "LipLeg" at the end of 2024. Based on this decision, inpatient and outpatient surgical treatment of stage III lipoedema can be billed to the GKV, while the reimbursement of costs for surgical treatment of the other two stages remains a case-by-case decision of the GKV and is currently often rejected. Therefore, treatment costs are often paid by patients themselves. The question of the correct settlement of lipoedema treatment repeatedly arises in the context of legal disputes, which, in turn, repeatedly faces experts and courts with a major challenge. In the following article, the Task Force Lipoedema of the German Society for Plastic, Reconstructive and Aesthetic Surgery presents an overview of the various billing modalities and presents a proposal for the correct billing of lipoedema within the framework of the German medical fee schedule ("Gebührenordnung für Ärzte", GOÄ).

[Complications and their management in the surgical treatment of lipohyperplasia dolorosa]. / Komplikationen und deren Management bei der chirurgischen Behandlung der Lipohyperplasia dolorosa.

BACKGROUND: There are both conservative and surgical treatment options for lipohyperplasia dolorosa (LiDo). A procedure that has been established since 1997 is the surgical treatment through lymphological liposculpture according to Cornely™. AIM: After extensive suctioning of the extremities, an extensive subcutaneous wound cavity with a trabecular connective tissue scaffold remains. Nevertheless, surgery-related complications are rare. Postoperative management and administration of antibiotics and antithrombotics are reviewed. The therapies for complications are presented in detail. MATERIALS AND METHODS: Retrospectively, the frequencies of adverse events in 1400 LiDo surgeries in 2020 were evaluated. The mean age of the patients was 47.81 years (range 16-78 years). Symmetrically, 504 outer legs (outer half of the limb [BA]), 504 inner legs (inner half of the limb [BI]), and 392 arms [A] were surgically treated. RESULTS: Relevant adverse events rarely occurred: infections (1.79%), seromas (0.79%), erysipelas (0.28%), necrosis (0.14%) and deep vein thrombosis (0.07). DISCUSSION: We were able to reduce the rate of postoperative complications to 3.07% in the Lymphological Liposculpture™ regime for the surgical treatment of LiDo. In their meta-analysis on liposuction, Kanapathy et al. reported an overall incidence of major surgical complications of 3.48%. The overall incidence of minor surgical complications was 11.62%, with seroma (5.51%) being the most common minor complication [26]. Kruppa et al. report that the liposuction procedure including fat removal for esthetic reasons has a complication rate of 9.5%. Wound infections with 4.5% and the formation of erysipelas with 4% are clearly in the foreground [20].

Complications and their management in the surgical treatment of Lipohyperplasia dolorosa. English version.

BACKGROUND: There are both conservative and surgical treatment options for Lipohyperplasia dolorosa (LiDo). A procedure that has been established since 1997 is the surgical treatment through Lymphological Liposculpture according to Cornely™. AIM: After extensive suctioning of the extremities, an extensive subcutaneous wound cavity with a trabecular connective tissue scaffold remains. Nevertheless, surgery-related complications are rare. Postoperative management and administration of antibiotics and antithrombotics are reviewed. The therapies for complications are presented in detail. MATERIALS AND METHODS: Retrospectively, the frequencies of adverse events in 1400 LiDo surgeries in 2020 were evaluated. The mean age of the patients was 47.81 years (range 16-78 years). Symmetrically, 504 outer legs (outer half of the limb [BO]), 504 inner legs (inner half of the limb [BI]), and 392 arms [A] were surgically treated. RESULTS: Relevant adverse events rarely occurred: infections (1.79%), seromas (0.79%), erysipelas (0.28%), necrosis (0.14%) and deep vein thrombosis (0.07). DISCUSSION: We were able to reduce the rate of postoperative complications to 3.07% in the Lymphological Liposculpture™ regime for the surgical treatment of LiDo. In their meta-analysis on liposuction, Kanapathy et al. reported an overall incidence of major surgical complications of 3.35%. The overall incidence of minor surgical complications was 11.62%, with seroma (5.51%) being the most common minor complication [26]. Kruppa et al. report that the liposuction procedure including fat removal for esthetic reasons has a complication rate of 9.5%. Wound infections with 4.5% and the formation of erysipelas with 4% are clearly in the foreground [20].

[Pain in lipoedema, fat in lipoedema and its consequences: results of a patient survey based on a pain questionnaire]. / Der Lipödemschmerz, seine Folgen auf die Lebensqualität betroffener Patientinnen ­ Ergebnisse einer Patientenbefragung mittels Schmerzfragebogen.

640 patients from a specialist clinic for operative lymphology were surveyed with the help by a questionnaire issued by the German Society of Pain Therapy (Deutsche Schmerzgesellschaft e. V.). This survey collected responses to questions about pain and pain characteristics as well as demographic data. It revealed that only a little more than 50 % of respondents were genuine cases of obesity. Lipoedema and obesity must therefore be regarded as clinical pictures unrelated to one another. The pain was mostly described as pressing and tearing in nature. Attributes such as throbbing or pulsing, consistent with acute inflammation, were rated as "not applicable". Symptoms were independent of the BMI, which is only useable to a limited extent in lipohyperplasia dolorosa. On the whole, the main symptom "pain" is multi-faceted. The study initiated by the German Federal Joint Committee (G-BA) must therefore be viewed critically. Congenital (as opposed to acquired) lipoedema fat on the extremities significantly impairs a person's ability to undertake activities in general as well as leisure activities. Since no objectively verifiable findings in lipoedema can be ascertained thus far, the diagnosis should be based on a careful patient survey.